Otitis Externa Flashcards
Otitis Externa
inflammation of the outer ear canal, seen in older patients
the cause is bacterial, viral or fungal and the patient usually complains of severe pain
clinical features
minimal discharge, itch, severe pain and tragal tenderness due to acute inflammation of skin of meatus
debris in canal
redness and swelling of ear canal
describe the discharge
scanty watery discharge as there are no mucinous glands
hearing?
if the canal becomes blocked by swelling or secretion - hearing can be affected
aetiology
- moisture (swimming)
- trauma (fingernails eg from chronic itch (psoriasis/eczema)
- high humidity, absence of wax, narrow ear canal, hearing aids
- seborrhoeic dermatitis
bacterial causes
Pseudomonas is the chief organism
S. Aureus is also seen
fungal causes
- aspergilllus niger
candida albicans
what is the key to treatment
aural toilet
how may pain be treated
analgesia and application of local heat
treatment of mild cases
dont swab
Acetic Acid 2% (Earcalm) for 7 days, treat as moderate if no improvement after 3 days
treatment of moderate cases
- pope wick for swelling
- topical corticosteroid adn ABx eg Otomize or Sofradex
which cases should be swabbed
only severe - if unresolving after one course of treatment for moderate symptoms, swab and prescribe antimicrobials
treatment for fungal infections
topical Clotrimazole
treatment for Gram negatives
Gentamicin
malignant OE
spread of OE into the surrounding tissue - aggressive, life-threatening infection that can lead to temporal bone destruction and base-of-skull osteomyelitis, this can progressively involve the skull and meninges
signs of malignant OE
- granulation tissue at bone-cartilage junction of ear canal, exposed bone in the ear canal
- facial nerve palsy
